Some drugs and certain quantities of some drugs require approval before they are eligible for coverage under your pharmacy benefits. These medications are on the prior-authorization list because they have a limited place in therapy or a narrow therapeutic margin, require special monitoring or could be misused or abused. For prior authorization approval, a doctor needs to provide clinical information to HometownRx to be reviewed by our Clinical Pharmacist for medical necessity and appropriateness of therapy.
Who can request a Prior Authorization?
Providers
We encourage providers to fax in our prior authorization request form to 866-521-9916.
Members can request prior authorization for their medications by calling our pharmacy customer support team at 844-373-0970 Monday – Friday 8 a.m. to 5 p.m. PST.
Terms and Conditions
Prior authorizations can take up to 7 business days for a decision to be made.
It is up to the doctor or member to request authorization renewal to ensure there is no gap in care.
If a medication is purchased outside of the authorization approval window, the claim would not be eligible for reimbursement.